Evaluation of the Combination of Romidepsin and Carfilzomib in Relapsed/Refractory Peripheral T Cell Lymphoma Patients

Inclusion Criteria:

* Age ≥ 16 years of age
* Life expectancy \> 12 weeks
* ECOG performance status ≤ 2
* Relapsed or refractory peripheral T-cell lymphoma including the following histologies: peripheral T-cell lymphoma not otherwise specified, angioimmunoblastic T-cell lymphoma, anaplastic large cell lymphoma, enteropathy associated T-cell lymphoma, extranodal NK/T-cell lymphoma, transformed mycosis fungoides, hepatosplenic T-cell lymphoma \[For all relapsed patients, relapse must be confirmed by tissue biopsy (or bone marrow trephine if no other tissue available). For refractory patients, a biopsy must have been obtained within the last 6 months and preferably to confirm refractory disease. In rare cases (such as when re-biopsy is not possible), the initial diagnostic biopsy may be accepted, provided that the patient has been reviewed at the local MDT who agreed that the presentation is consistent with relapsed/refractory T cell lymphoma, and this has been documented.\]
* Failed at least 1 prior therapy (but no upper limit of prior regimens)
* Patients MAY have had a prior allogeneic stem cell transplant but must not require systemic immunosuppression for graft-versus-host disease (local treatments are permitted)
* Adequate haematopoietic reserve (Hb ≥ 9g/dl, neutrophils ≥ 1.0x10\^9/l and platelets ≥ 100x10\^9/l or ≥ 75x10\^9/l if marrow involvement documented)
* Adequate liver function (bilirubin ≤ 1.5 x upper limit of normal (ULN) (unless due to Gilbert's syndrome), AST / ALT ≤ 2x ULN)
* Adequate renal function (creatinine clearance ≥ 20ml/min as assessed by Cockcroft and Gault calculation)
* Serum potassium ≥ 3.8 mmol/l, calcium ≥ 2.2 mmol/l and magnesium ≥ LLN prior to trial entry (supplements permitted)
* CT measurable disease with at least 1 lesion having short axis \> 1.5cm or splenomegaly \> 14cm in cranio-caudal length attributable to relapsed lymphoma
* Ability to give informed consent

Exclusion Criteria:

* Persistent treatment related toxicities of CTCAE v4.0 grade ≥ 2
* Previous treatment with histone deactylase inhibitor or proteasome inhibitor
* Need for any other concurrent anti-cancer drug (apart from corticosteroids at a dose equivalent to prednisolone ≤ 7.5mg daily). A steroid prephase may be used but should be stopped by the first day of cycle 1.
* Concurrent medical illness deemed by the investigator as uncontrolled and/or clinically significant
* Previous systemic malignancy within the last 3 years unless treated with curative intent with no sign of recurrence. Other exceptions include non-melanotic skin cancer or carcinoma in-situ of the uterine cervix
* Co-existing active infection requiring parenteral antibiotics
* Patients unable to swallow oral medication
* Active infection with HIV, hepatitis B or hepatitis C
* Radiotherapy\* (except for palliative reasons), endocrine therapy, immunotherapy or use of other investigational agents within 28 days prior to trial entry (or a longer period depending on the defined characteristics of the agents used, please contact the trials office for confirmation). \*Limited field radiotherapy to an isolated lesion in bone or soft tissue must be completed 2 weeks prior to trial entry
* Major surgery within 4 weeks of trial entry
* Patients with proven CNS involvement
* QTc interval of \>450ms or patients taking medications that significantly prolong the QT interval
* Patients taking any inhibitors or strong inducers of CYP3A4, with the exception of dexamethasone.
* Clinically significant cardiac disease ≥ NYHA Class III, symptomatic ischaemia, conduction abnormalities uncontrolled by conventional intervention or myocardial infarction within 6 months of trial entry
* Pregnant and lactating patients (patients of childbearing potential must have a negative pregnancy test prior to study entry and within 7 days prior to the start of treatment. Postmenopausal females (\> 45 years old and without menstruation for \> 1 year) and surgically sterilised females are exempt from a pregnancy test)
* Patients and partners of childbearing potential not willing to use effective contraception during and for 3 months after therapy
* Concurrent Pulmonary Hypertension
* Left Ventricular Ejection Fraction (LVEF) of \<40%